Inflammation

Pathophysiology

Part of body’s biological response to harmful stimuli, such as irrants, pathogens, and damaged cells

Non-pharmacological Treatment (Ice vs. Hot)

Cold therapy (Cryotherapy) — reduces pain, decreased blood flow, inflammation, muscle pain, and metabolic demand (recommended for ACUTE inflammation)

Heat therapy — pain relief, increased blood flow, enhanced tissue metabolism, decreased muscle spasm, and increased elasticity of connective tissue (recommended for CHRONIC inflammation)

Ibuprofen (First Gen. NSAIDs) Mechanism of Action

Inhibit the action of COX

Ibuprofen Administration

Make sure clients swallow enteric-coated or sustained-release forms whole and do not crush or chew them

Discontinue 1 week before scheduled surgery

Monitor for initial and continued therapeutic effects

Ibuprofen Contraindications

Teratogenic

Hypersensitivity to aspirin and other NSAIDS

Peptic ulcer disease

Bleeding disorders (hemophilia, vitamin K deficiency)

Children or adolescents with chickenpox or influenza (especially aspirin)

Perioperative use prior to coronary artery bypass grafting (non-aspirin NSAIDs)

Discontinue within 1 week of any elective surgery (aspirin)

Ibuprofen Drug Interactions

Anticoagulants, glucocorticoids, and alcohol increase the risk of bleeding

Ibuprofen decreases the antiplatelet effects of low-dose aspirin

ACE inhibitors and angiotensin receptor blockers increase the risk of kidney failure

Antihypertensive effects of ACE inhibitors decrease the risk of lithium carbonate and methotrexate toxicity increases

Ibuprofen Nursing Interventions

Monitor for manifestations of gastrointestinal bleeding (black or dark colored stools, abdominal pain, nausea, hematemesis)

Test for and treat Helicobacter pylori infection prior to long-term therapy

For clients at high risk for gastric bleeding, recommend a proton pump inhibitor

Monitor for manifestations of bleeding (easy bruising, petechiae, excessive bleeding from minor injuries)

Monitor intake and output; watch for low urine output and fluid retention

Monitor for rapid rises in BUN and creatinine

Monitor for tinnitus, diaphoresis, headache, dizziness, and respiratory alkalosis

Stop aspirin therapy for clients reporting these manifestations

Recommend acetaminophen and not aspirin or NSAIDs for children and adolescents under age 18 who have viral infections, particularly chickenpox and influenza

Recommend non-aspirin NSAIDs for short periods and in low doses only

Recommend low-dose aspirin to prevent these events if prescribed by provider

Monitor for manifestations of myocardial infarction and cerebrovascular accident

Ibuprofen Patient Teaching

Take with food, milk, or 8 oz of water to minimize gastrointestinal effects

Avoid alcohol

Report persistent gastric irritation and manifestations of bleeding

Report any unusual or prolonged bleeding

Report changes in urine output, weight gain, or manifestations of fluid retention such as edema or bloating

Report ringing or buzzing in the ears, sweating, headache, and dizziness

Stop taking aspirin if these manifestations develop

Do not give aspirin or NSAIDs to children under age 19 who have viral infections, particularly chickenpox and influenza; use acetaminophen instead

Report chest pain or heaviness, shortness of breath, sudden and severe headache, numbness, weakness, visual disturbances, or confusion

Take low-dose aspirin once daily to reduce the risk of heart attack and stroke if prescribed

Prednisone (Glucosteroid) Mechanism of Action

Mimic cortisol by suppressing inflammation and the immune response

Inhibits the synthesis of prostaglandins (decreases pain)

Prednisone Administration

Give orally (prednisone), IV, IM, SC, topically, intranasally, or by inhalation, depending on the indication and medication used

For long-term use (10 days or more), take in the morning using alternate day dosing

Taper the dose slowly when manifestations are controlled to establish the lowest possible oral dose

For short-term oral use, the largest dose is given on the 1st day with progressively smaller doses for each of the next 8 days

Give supplemental doses as needed in times of stress

Prednisone Contraindications

Recent live virus immunization

Systemic fungal infection

Cataracts

Prednisone Drug Interactions

Potassium-depleting diuretics, such as furosemide, increase risk of hypokalemia

The risk of digoxin-induced dysrhythmias increases with digoxin

NSAIDs increase risk of gastrointestinal bleeding and ulceration

Effects of insulin and oral hypoglycemics decrease in clients who have diabetes

Prednisone prevents the body from responding to vaccines

Live vaccine administration increases risk for decreased antibody response and increased risk of adverse effects

Prednisone Nursing Interventions

Recommend larger dosage during times of illness and stress

Monitor blood glucose levels, especially for clients who have diabetes mellitus

Adjust dosages of insulin/hypoglycemic medications accordingly

Recommend the lowest possible effective dose and alternate-day dosing

Observe for gastrointestinal bleeding (bloody vomitus as well as black, tarry stools)

Implement gastric protective measures

Give medication with food or meals

Recommend analgesic substitute if NSAID is prescribed

Observe for manifestations of infection that may not include fever or inflammation (sore throat, fatigue, tachycardia, and discharge from a wound)

Recommend initiation of appropriate antimicrobial therapy

Monitor intake and output; watch for edema, crackles in the lungs, and unexplained weight gain (hypernatremia)

Monitor for generalized weakness (hypokalemia)

Monitor for Cushing-like effects: abdominal fat, buffalo hump, and moon face

Determine schedule for regular ophthalmologic examinations

Prednisone Patient Teaching

Report increased stress, as higher dosages are required at such times

Taper the dose before discontinuing it

Report polyphagia, polydipsia, and polyuria

Report muscle pain or weakness

Avoid taking NSAIDs

Take the medication with food or meals

Report indigestion or bloody vomitus as well as black, tarry stools

Report manifestations of infection, such as a sore throat

Report weight gain or edema (hypernatremia)

Report weakness (hypokalemia)

Understand that long-term therapy may cause some changes in fat distribution throughout the body

Take the medication on alternate days for long-term therapy

Perform weight-bearing exercise daily

Consume adequate calcium and vitamin D

Report blurred vision and loss of color acuity

Minimize exposure of eyes to sunlight

Obtain periodic eye examinations